Changes in charges and costs associated with hospitalisation of patients with mandibular fractures between 1991 and 1993

Purpose: The purpose of the study was to examine the changes in costs, charges, and income related to hospitalization of patients with mandibular fractures treated over a 3-year period. Patients and Methods: The study involved retrospective analysis of data on 97 patients treated by the Department of Oral and Maxillofacial Surgery between 1991 and 1993. Biographical data were obtained from the Trauma Registry, and the financial data were obtained from the Financial Services Administration. The study examined the changes in costs and charges of hospitalization, insurance status, reimbursement, total revenue, and income losses from hospitalization of patients admitted with a primary diagnosis of mandibular fracture. In addition, the study examined the changes in costs of major items involved in treatment. Possible variables such as age, gender, and cause of fracture were also recorded. Results: Twenty-nine patients were admitted in 1991, 35 in 1992, and 33 in 1993. These patients were predominantly young males. The average cost of treatment decreased by 2% in 1992 and increased by 58% in 1993. The average charge increased by 12.9% in 1992 and by 76.8% in 1993. The total reimbursement increased by 11.2% in 1992 and by 47.7% in 1993. The average payment per patient to the institution by third-party payers decreased by 7.8% in 1992 and increased by 56.6% in 1993. The loss of income to the institution (cost minus reimbursement) increased by 105.9% in 1992 and by 58% in 1993. The average institution income loss from the care for each patient increased by 70.6% in 1992 and by 67.8% in 1993. Conclusions: This study showed that there was a continued increase in costs, charges, and income loss for hospitalization of mandibular fracture patients during the years 1991 to 1993, whereas the reimbursement rate decreased from 65% to 47% of the charges. The increase in cost of supplies and use of rigid fixation, the increase in the number of uninsured patients, and the pricing practices of the institution were possible causes of these changes.